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General NPI Number Information
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NPI Number | 1861357691
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Entity Type | Individual
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Provider Name | JESSE SANDERS
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Gender | Male
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Dates
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Enumeration Date | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 1898 FORT RD
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City | SHERIDAN
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State | WY
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Zip | 82801-8320
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Country | US
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Telephone | 602-717-4953
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Fax |
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Provider Business Mailing Address
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Address Line | 406 BIG ROCK LAKE RD
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City | PICKENS
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State | SC
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Zip | 29671-9284
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Country | US
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Telephone | 602-717-4953
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 265112
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License Number State | SC
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